SASP Annex a Section 2 ONLY

SECTION 2

PROGRAM INFORMATION

The following four parts must be completed for

each individual

contracted program/component

Please note that additional requirements or stipulations may be necessary for an identified program and will be forwarded to you, as applicable, by the Department of Children and Families, Office of Contract Administration.

(Please Note: Effective 9/2011 Section 2.1 of the Annex A has been removed from the package to facilitate the DCF Resource Directory. This section of the Annex A will be provided to you for completion by DCF Contract Administrators.)

SECTION 2 Program Description and Service Delivery Information

One set is completed for each contracted program/component. Make additional copies as necessary. They can also be downloaded from the Office of Contract Administration website at clicking on the link to “Contract and RFP Information”.

Section 2.1: Program Name and Service Delivery Information

Effective 9/1/2011,Section 2.1 has been removed from the Standardized Annex A. DCF has reformatted Section 2.1 in order to facilitate the establishment and ongoing maintenance of a DCF Resource Directory. Your DCF Contract Administrator will email a partially completed Section 2.1 for each contract component to your agency at the time of contract renewal. The Section 2.1 form is still a required document and a part of a complete Annex A submission. Please remember to email the completed Section 2.1 to your Contract Administrator(s) as part of your Annex A submission(s).

Section 2.2: Program Description

Answer and clearly label all questions as outlined.

Note: Questions asked may not be all inclusive. You will be notified of any other Required Program Description and Deliverables for your specific program, as applicable, to complete your contract package.

Section 2.3: Performance Outcomes

This section should be negotiated with the managing Contract Office and program staff, where applicable, prior to inclusion in the contract package.

Section 2.4: Program Personnel Information Sheet

Note: If agency is contracted for 5 programs, and a social worker works in all of these programs, list this person on the core agency personnel sheet (Section 1.3). If the social worker works in only four out of the five programs, do not include this person on the core agency personnel sheet. This staff person will be listed on each of the four relevant program personnel sheets (Section 2.4) which is part of Section 2.

Column 1: List all full-time and part-time positions dedicated to and funded by each program. List the title of each full-time and part-time position in your agency. Check appropriate box.

Columns 2 through 5: Complete the remainder of the form by listing for each position, in the appropriate column, the following information:

Name of employee
Work hours (general-not specific to program)
Indicate percentage of employee’s compensated time that is dedicated to the program (Example: If the employee is a social worker who works for 4 of the 5 agency’s funded programs, then the employee’s time should be apportioned, as such)
Qualifications, including degrees, licenses, certificates, etc. that the employee possesses and which are pertinent to his/her position; and
The functional job duties of the employee

Note: Staff listed on the personnel information forms (Section 1.3 and Section 2.4) must also be represented on the Annex B budget presentation, when applicable.

Section 2.5: Level of Service Form

A monthly contracted level of service chart is to be completed for each program/component, if applicable.One program might require several LOS forms to be completed which can be downloaded from the website. This will be indicated to you by the Contract Administrator and/or in the renewal/award letter.

The information on this form is usually utilized as a reference/source document when completing reporting forms during the contract term, when required by DCF.

Service Type: Per service dictionary, contact your contract administrator (i.e. individual counseling, residential placement, legal assistance, transportation)

Description of Unit Measurement: Indicate what is being used as the measurement for monthly Contracted Level of Service (CLOS), (i.e. beds, rides, sessions, hours)

Number of Contracted Slots/Units: Numbers should reflect unduplicated service counts. Unduplicated service counts refers to the practice of counting a customer receiving services only once within a service cycle.

Refer to Annex B2 and or Renewal/Award Letter for this number. (i.e. # of beds, # of rides, # of sessions, # of hours)

Annualized Units: Equivalentto the Annual Total under Column 3 on chart.

Column 1:Select Month from drop down menu. Month 1 should reflect 1st month of Contract.

Column 2: Indicate Actual Number of Expected Days of Service or Units Per Month.

Column 3: Indicate total Contracted LOS per month, this could be ‘Days of Service’ multiplied by Number of Contracted Slots/Units per month or equivalent to number listed in Column 2.

Annual Totals: This number will equal annualized number of units to be contracted per program type.

Program Description cont.

Contract Number:

STATE OF NEWJERSEY

DEPARTMENT OF CHILDREN AND FAMILIES

Annex A

PROGRAM DESCRIPTION

Section 2.2

Program Name: / Sexual Assault Services Program (SASP)

Please note that additional information/addenda may be required in order to complete the contract package. Any specific requirements/stipulations pertaining to the program will be forwarded as applicable.

Label all answers clearly as outlined below:

1.Provide a brief program/component description and its purpose. The description should reflect the program requirements set forth in the initial RFP and any changes that may have resulted from negotiations.

The Sexual Assault Services Grant Program (SASP) was created by the Violence Against Women and Department of Justice Reauthorization Act of 2005 (VAWA 2005), 42 U.S.C. §14043g, and is the first Federal funding stream solely dedicated to the provision of direct intervention and related assistance for victims of sexual assault.

The purpose of these is to provide intervention, advocacy, accompaniment, support services, and related assistance to adult, youth, and child victims of sexual assault, family and household members of such victims, and those collaterally affected by the victimization, except for the perpetrator of such victimization.

By statute, funds under the Sexual Assault Services Programmay be used for the following purposes: To support the establishment, maintenance, and expansion of Sexual Violence Programs, and other programs and projects, to assist those victimized by sexual assault.

2.Identify the target population served by this program/component (i.e. individuals who have been unemployed for the past 6-12 months).

Indicate the program’s level of experience with the target population.
Provide a brief outline or snapshot of the characteristics, needs, and current circumstances of the customers the program intends to serve.
Explain how these customers are distinct in any way from the general population. It is generally viewed as a sign of strength when a program is able to identify the population that will benefit the most from the services provided.

3.Detail what the program intends to address through service delivery. State the results the program intends to achieve.

The emotional and psychological injuries that are inflicted on victims of sexual violence are often more serious than the physical injuries suffered. Every aspect of a victims life can be impacted including health, relationships, school/work, and eating/sleeping patterns. The availability of immediate crisis services and counseling is often a successful treatment to ease the profound psychological trauma experienced by these victims and their families. Sexual Violence Programs are funded to facilitate victim healing by providing an immediate crisis response and supportive counseling. Healing times are generally shorter and the impact of sexual violence is less profound when victims receive the support of trained Confidential Sexual Violence Advocates.

4.Describe the program service delivery method (i.e. in the community, on site).

SASP funds will be used to develop/sustain programs and activities that provide direct intervention and related assistance which may include any of the following statutory program purposes: (please check those that apply to your program and provide detail below each)

Twenty-four hour hotline services providing crisis intervention services and referral;

Accompaniment and advocacy through medical, criminal justice, and social support systems, including medical facilities, police and court proceedings;

Crisis intervention, short-term individual and group support services, and comprehensive service coordination and supervision to assist sexual assault victims and non-offending family or household members;

Information and referral to assist the sexual assault victim and non-offending family or household members

Community-based, linguistically and culturally specific services and support mechanisms, including outreach activities for underserved communities; and

The development and distribution of materials on issues related to the services described above.

5.Detail how customers access services.

Cite any physical limitations that might preclude program admission or referral acceptance
Discuss referral procedures and discharge planning with respect to the continuum of care
Cite negative and planned discharge procedures
Indicate specific documents needed for referrals, when applicable

6.Describe the neighborhood(s) and the building(s) where each program site(s) is located.

Administrative Site name:

Address:

Town, City, Zip:

Program Site Name (if different from administrative site):

Address:

Town, City, Zip:

Detail accessibility to mass transportation. Identify the program catchment area.

7.Detail the program’s emergency procedures. Provide any after-hours telephone numbers, emergency contacts, and special instructions.

8.Provide the total number of unduplicated customers served in the previous contract period for each of the contracted programs. Unduplicated customers refers to the practice of counting a customer receiving services only once within a service cycle.

Indicate the number of unduplicated customers achieving results.
Indicate how the information was captured and measured.

9.Please describe how the program collaborates and/or networks with law enforcement agencies, the county prosecutor’s office, emergency medical facilities, sexual assault forensic/nurse examiner program and other victim agencies within the county includingother public and private entities to best serve the target population by this program/component. (Please provide copies of any written agreements/sub-contracts/MOU’s)

ADDITIONAL CONTRACT REQUIREMENTS

Reports:

The following is an excerpt form the Sexual Assault Services Program Reporting Manual that was included with your contract renewal packet. Please see the manual for definitions, guidelines, and specific format for reports.

SEXUAL ASSAULT SERVICES PROGRAM REPORTS (SASP)
Type / Period / Due Date

Narrative Reports
Performance Reports

/ 1st Half (January 1st to June 30th ) / July 15th
2nd Half (July 1st to December 31st ) / January 15th

Annual Progress Report (Muskie)

/ January 1st toDecember 31st / February 15th

All reports should be sent via email to: The Division on Women and your Contract Administrator.

All quarterly expenditure reports must be submitted using the Annex B format found on the DCF website: Each quarterly expenditure report is due no later than the 20th of the month following the close of a quarter. Please submit your reports electronically via email to both the Division on Women and your DCF contract administrator.

ALLOWABLE BUDGET ITEMS

The following applies to this contract:

SAARC/SASP Funds cannot be used to support sexual assault forensic examiner projects or criminal justice activities (e.g., law enforcement, prosecution, courts, or forensic interviews).
SAARC/SASP Funds cannot be used for: lobbying, fundraising, purchase of real property, construction, physical modifications to building, including minor renovations (such as painting or carpeting).
General and Administrative costs cannot exceed 5% of SASP contract funds.

CONFIDENTIAL SEXUAL VIOLENCE ADVOCATE TRAINING

All paid and unpaid advocates who have direct contact with victims and all prevention education staff and volunteers must complete a minimum forty (40) hour confidential sexual violence advocate training pursuant to N.J.S.A. 2A:84A-22.14. A detailed training syllabus must be provided in writing by the grantee and further approved by the Division on Women.

PUBLICATIONS

The provider shall specify on publications, public service announcements, reports, etc. that, “This (publication, etc.) was supported by Department of Children and Families-Division on Women grant funds and its contents are solely the responsibility of the author and do not necessarily represent the official views of the Department of Children and Families-Division on Women.”

VICTIM CONFIDENTIALITY

All victim services are to be provided in a manner that guards victim privacy and maintains the victim’s right to confidentiality pursuant to N.J.S.A. 2A:84A-22.15. In addition the host agency will ensure that training and supervision of all paid and unpaid confidential sexual violence advocates are in accordance with N.J.S.A. 2A:84A-22.14 to ensure that advocates qualify to claim the victim counselor confidentiality privilege. The host agency shall have policies and procedures for the handling of court orders and the maintenance of victim files, and as part of those policies and procedures, take all actions to ensure victim confidentiality pursuant to the victim counselor confidentiality statute.

CHILD ABUSE AND NEGLECT

In New Jersey, any person having reasonable cause to believe that a child has been subjected to abuse or acts of abuse should immediately report this information to the State Central Registry (SCR).

All reports of child abuse and neglect, including those occurring in institutional settings such as child care centers, schools, foster homes and residential treatment centers, must be reported to the State Central Registry (SCR). This is a toll-free, 24-hour, seven-days-a-week hotline.

Child Abuse Hotline (State Central Registry)

1-877 NJ ABUSE

(1-877-652-2873)

TTY 1-800-835-5510

ABUSE

Abuse is the physical, sexual or emotional harm or risk of harm to a child under the age of 18 caused by a parent or other person who acts as a caregiver for the child.

NEGLECT

Neglect occurs when a parent or caregiver fails to provide proper supervision for a child or adequate food, clothing, shelter, education or medical care although financially able or assisted to do so.

Contract Number:

STATE OF NEWJERSEY

DEPARTMENT OF CHILDREN AND FAMILIES

Annex A

PERFORMANCE OUTCOMES

Section 2.3

Program Name: / Sexual Assault Services Program (SASP)

For each program component please identify: goals, objectives, activities, and performance outcomes, using the following definitions and the chart below.

GOALS:

Goals are statements detailing the long term, ongoing aims or intentions of each program component. Goals do not have a specific time limit but are designed to produce the desired results over an extended time period. Achievement of goals may reach beyond the contract period.

OBJECTIVES:

Objectives are statements detailing the desired results of day to day activities. These are short term milestones to be achieved during the contract period. Objectives are reflective of the long term goals of the program component and ideally lead to achievement of those goals. Objectives have defined time limits and measurable results.

ACTIVITIES:

Activities are tasks performed to achieve identified objectives. These should be observable and/or measurable.

PERFORMANCE OUTCOMES:

Performance outcomes are the identified, quantifiable impact results of the program component on the target population. They should be tied to the program goals rather than to each objective or activity. Performance outcomes may be attainable during the contract period or it may be necessary to track their attainment over a longer period of time.

Contract Number:
Program Name: / Sexual Assault Services Program (SASP)

PERFORMANCE OUTCOMES

GOALS / OBJECTIVES / ACTIVITIES / PERFORMANCE OUTCOMES
1. / 1. / 1. / 1.
2. / 2.
3. / 3.
4. / 4.
5. / 5.
2. / 1. / 1. / 2.
2. / 2.
3. / 3.
4. / 4.
5. / 5.
3. / 1. / 1. / 3.
2. / 2.
3. / 3.
4. / 4.
5. / 5.
4. / 1. / 1. / 4.
2. / 2.
3. / 3.
4. / 4.
5. / 5.
5. / 1. / 1. / 5.
2. / 2.
3. / 3.
4. / 4.
5. / 5.

Contract Number:

STATE OF NEWJERSEY

DEPARTMENT OF CHILDREN AND FAMILIES

Annex A

PROGRAM PERSONNEL INFORMATION

Section 2.4

Program Name: / Sexual Assault Services Program (SASP)
POSITION NAME/TITLE / NAME OF EMPLOYEE / DAILY WORK HOURS / %OF TIME TO PROGRAM / QUALIFICATIONS
(DEGREES, LICENSES, CERTIFICATIONS) / FUNCTIONAL JOB DUTIES
FROM / TO
FT
PT / %
FT
PT / %
FT
PT / %
FT
PT / %
FT
PT / %
FT
PT / %
FT
PT / %
FT
PT / %
FT
PT / %
FT
PT / %

STATE OF NEWJERSEY

DEPARTMENT OF CHILDREN AND FAMILIES

Annex A

PROGRAM PERSONNEL INFORMATION

Section 2.4 Continued

Contract Number:

STATE OF NEWJERSEY

DEPARTMENT OF CHILDREN AND FAMILIES

Annex A

LEVEL OF SERVICE

Section 2.5

Program/Component Name:
Service Type:
Description of Unit Measurement:
Number of Contracted Slots/Units:
Number of Annualized Units:

Numbers should reflect unduplicated service counts

1 / 2 / 3
MONTH / MONTHLY SERVICE DAYS
OR
UNITS / MONTHLY CONTRACT LOS
1 / JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember
2 / JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember
3 / JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember
4 / JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember
5 / JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember
6 / JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember
7 / JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember
8 / JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember
9 / JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember
10 / JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember
11 / JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember
12 / JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember
ANNUAL
TOTALS